Cutaneous basal cell carcinosarcoma: case report and literature review

Abstract

Carcinosarcomas are malignant neoplasms with biphasic carcinomatous and sarcomatous or sarcoma-like components. In general, the sarcomatous component is accepted to be the result of divergent mesenchymal differentiation of the epithelial component. Although well characterized in some anatomic locations (e.g. uterus, upper aerodigestive tract and lung), carcinosarcomas of the skin are rare. Reported epithelial components include squamous, adnexal, neuroendocrine and basaloid. Including this case, only 47 cases of primary cutaneous basal cell carcinosarcoma have been reported in the literature to date. We performed an extensive immunophenotypic evaluation in our case, which confirmed the previously reported coexpression of p53 in both components, and revealed a hitherto unreported coexpression of p16 and p63. Additionally, this report reviews the clinical, pathologic, immunophenotypic characteristics and outcomes of the basal cell carcinosarcomas reported in the literature, in order to emphasize the overall uniform characteristics and clinical behavior of this neoplasm.

A Case of Primary Cutaneous Basal Cell Carcinosarcoma

“…3d). These histological and immunohistological characteristics were consistent with those of the previously reported case of basal cell CS [2]. Both epithelial and mesenchymal components were 70–80% positive for Ki-67, which suggested that the mesenchymal cells represented a sarcomatous progression of BCC, resulting in a diagnosis of basal cell CS.…”

“…The sarcomatous components has been recognized as a metaplastic carcinoma of the epithelial components [2]. Metaplastic carcinoma demonstrates the proliferation of spindle cells sometimes associated with ossification and chondrification.…”

“…The recurrence or metastatic rate of CS may depend on the histological characteristics of epithelial components but not on those of mesenchymal components. In addition, since it is reported that the metastatic rate of BCC larger than 3 cm in diameter is 2% [2], the prognosis is not necessarily worse than that of large BCC.…”

Primary cutaneous biphasic sarcomatoid basal cell carcinoma with myoepithelial carcinoma differentiation: A new variant

“…The latter has been included in the well‐known and broad group of metaplastic carcinoma, but currently, it is regarded as a particular subset with different risk factors than the common hormone‐related adenocarcinomas of the breast . Primary cutaneous biphasic sarcomatoid carcinomas are very rare, with approximately 50 cases reported in the literature . In most of those cases, the epithelial component is a BCC or SCC, with only five published cases associated with porocarcinoma.…”

“…5 Primary cutaneous biphasic sarcomatoid carcinomas are very rare, with approximately 50 cases reported in the literature. 6 In most of those cases, the epithelial component is a BCC or SCC, with only five published cases associated with porocarcinoma. When malignant heterologous differentiation is present in the tumor, it is usually in the form of osteosarcoma, chondrosarcoma, rhabdomyosarcoma, or leiomyosarcoma.…”